Diabetes in Germany NATIONAL DIABETES SURVEILLANCE REPORT 2019
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NATIONAL DIABETES SURVEILLANCE REPORT 2019 Diabetes in Germany
NATIONAL DIABETES SURVEILLANCE REPORT 2019 Diabetes in Germany
4 Robert Koch Institute National Diabetes Surveillance
Content
Introductory remarks 7
Foreword 9
Summary 10
Introduction and background 13
What is diabetes mellitus? 13
What are the aims of the Diabetes Surveillance in Germany? 14
What content comprises the Diabetes Surveillance? 14
Which data sources are used by the Diabetes Surveillance? 16
What does this report contain? 17
Field of action 1
Reducing the risk of diabetes 18
Background 19
Results at a glance 19
Within the health policy context 20
Next steps for the Diabetes Surveillance at the Robert Koch Institute 21
Fact Sheets
Incidence of documented diabetes 22
Prevalence of gestational diabetes 24
Overweight and obesity 26
Physical inactivity 28
Smoking 30
Field of action 2
Improving the early detection and treatment of diabetes 32
Background 33
Results at a glance 33
Within the health policy context 34
Next steps for the Diabetes Surveillance at the Robert Koch Institute 35
Fact Sheets
Prevalence of known and unknown diabetes 36
Prevalence of documented diabetes 38
Graded HbA1c target 40
Treatment profiles 42
Health-related quality of life 44
National Diabetes Surveillance Robert Koch Institute 5 Field of action 3 Reducing the complications of diabetes 46 Background 47 Results at a glance 47 Within the health policy context 48 Next steps for the Diabetes Surveillance at the Robert Koch Institute 49 Fact Sheets Depressive symptoms 50 Cardiovascular diseases 52 Diabetic kidney disease 54 Diabetic polyneuropathy 56 Diabetic foot syndrome 58 Diabetes-related amputations 60 Field of action 4 Reducing the burden and costs of disease 62 Background 63 Results at a glance 63 Within the health policy context 64 Next steps for the Diabetes Surveillance at the Robert Koch Institute 65 Fact Sheets Direct costs 66 Ambulatory care-sensitive hospitalisations 68 Reduced earning capacity pension 70 Mortality 72 Healthy life years 74 Outlook 76 Glossary 80 List of abbreviations 85 References 86
National Diabetes Surveillance Robert Koch Institute 7
Introductory remarks
There are currently around seven million people
with diabetes living in Germany, a figure which is
predicted to rise. We must confront this trend
head-on! Diabetes is not a harmless condition, it
has a negative effect on quality of life and can lead
to severe complications including renal failure,
amputations and blindness. There are various
modifiable risk factors for the common type 2 dia-
betes as well as some which are unmodifiable. For
this reason, it is important – without stigmatising
anyone – to increase health literacy among the
population in regard to both prevention and a
healthy lifestyle. The establishment of the National Diabetes Sur-
To effectively improve prevention and health care veillance in Germany has given us a reliable and
specific to the target groups, health policy, health comprehensive tool that will provide regular diabe-
research, health care and public health practice tes reporting based on relevant indicators, one
need reliable data and facts. These are provided by which distinguishes between age, sex and regional
the “Diabetes in Germany” report and by the distribution and illustrates trends over time.
National Diabetes Surveillance at the Robert Koch I would like to thank everyone who was
Institute, thereby helping to address the following involved in establishing the National Diabetes Sur-
questions: How many people are affected? How veillance in Germany, in particular, those who con-
will the prevalence of diabetes and the number of tributed to the report “Diabetes in Germany –
new cases per annum develop? How many people National Diabetes Surveillance Report 2019”. I
face an increased risk of developing diabetes? Have would also like to thank the co-operation partners,
specific treatment programmes improved care? whose key contributions helped secure external
How common are the various secondary diseases? data sources. Finally, my sincere thanks to the
What costs are associated with diabetes? members of the National Diabetes Surveillance
advisory board for their comprehensive scientific
and specialist advice and support.
Jens Spahn
Federal Minister of Health
Member of the German Bundestag
National Diabetes Surveillance Robert Koch Institute 9
Foreword
As a national public health institution, the Robert dynamics of the disease over time. The data sources
Koch Institute (RKI) bears responsibility for pro- were selected based on timely and constant availa-
tecting and promoting the health of the population bility, allowing for continuous reporting.
(public health) in Germany. This includes both Now at the end of the initial project phase, the
averting the acute threats posed by infectious dis- report of the Diabetes Surveillance in Germany is
eases to health and promoting measures to protect complete. It graphically depicts the disease’s devel-
against serious non-communicable diseases. opment and the distribution of risk factors. Aspects
Faced with these challenges, the RKI is tasked with of diabetes care, co-morbidities and secondary dis-
the continuous analysis of health developments eases have also been taken into account. The report
and threats to the population via reliable data has been prepared by the RKI in close collabora-
sources. The information gained provides a basis tion with an interdisciplinary scientific advisory
for health policy decisions on the planning and board and is supplemented by an interactive web-
implementation of long-term measures. The site (http://diabsurv.rki.de).
World Health Organization (WHO) defines this An important milestone for public health
fundamental task as “Public Health Surveillance”. reporting on diabetes has now been reached. And
Over the past century, the spectrum of dis- what are the next steps? As a public health institute,
eases and health risks faced by the population has we want to expand our surveillance system to
changed fundamentally. While infectious diseases include other major public health challenges. The
continue to pose an acute threat, non-communica- surveillance of infectious diseases and cancer is
ble diseases are now among the most common already well-established at the RKI. Our goal is to
causes of illness and death in adulthood worldwide. analyse and provide relevant data on other major
This shift has been fuelled by changes in lifestyle diseases such as cardiovascular diseases, lung dis-
and living conditions as well as an increase in life eases and mental illnesses such as depression. In
expectancy. this way, we can provide an information base with
Diabetes is one of the main non-communica- which to develop strategies together with policy-
ble diseases in Germany and many other countries makers and players within the health care sector so
and is a major public health challenge as a result. that as many people in Germany as possible can
Despite improvements in early detection and treat- lead a long and healthy life.
ment, many of those with diabetes develop serious
complications such as heart attack, stroke, ampu- Prof. Dr. Lothar H. Wieler
tation, blindness and dialysis. By far the most com- President of the Robert Koch Institute
mon form of diabetes is type 2 diabetes, which
mostly develops in late adulthood. Physical inactiv-
ity, smoking and obesity are some of the known
and potentially modifiable risk factors. These fac-
tors correlate strongly with psychosocial stress and
disadvantageous life circumstances. As a conse-
quence, international WHO action plans on
non-communicable diseases specifically target dia-
betes as well as cardiovascular diseases, cancer,
chronic respiratory diseases and mental illnesses.
Against this backdrop, the Federal Ministry of
Health (BMG) commissioned the RKI to establish
a diabetes surveillance system in Germany within
the scope of a research project. The objective was
to systematically collate information on diabetes
from available data sources in order to map the
10 Robert Koch Institute National Diabetes Surveillance
Summary
Diabetes is a chronic disease that represents a sig-
nificant public health challenge in Germany as
well as globally. Against this backdrop, the Federal
Ministry of Health (BMG) is funding the establish- Field of action 1
ment of a diabetes surveillance system for Ger- “Reducing the risk of diabetes”
many at the Robert Koch Institute (RKI). Based on
a set of defined indicators (key figures), the Diabe- Differing temporal developments and consider-
tes Surveillance aims to collate essential informa- able social differences are evident for key type 2
tion on diabetes from available data sources and to diabetes risk factors.
timely process this information so it can be used
as a basis for action for health policy, health
research, health care and public health practice. ▶▶ Claims data for all people covered by statutory
This is carried out in close co-operation with the health insurance shows that over 500,000 adults
Federal Centre for Health Education (BZgA), develop diabetes every year (fact sheet “Inci-
which is developing communication and informa- dence of documented diabetes”).
tion strategies on the prevention of diabetes and ▶▶ Gestational diabetes increases the risk for com-
related secondary diseases. plications in pregnancy and for the development
During the initial phase of the project of type 2 diabetes for the mother at a later stage.
(2015 – 2019), a structured, consensus-finding pro- According to documentation in pregnancy
cess was used to develop a scientific conceptual records 5.9 % of women giving birth in hospitals
framework for the Diabetes Surveillance with four have gestational diabetes (fact sheet “Prevalence
fields of action and 40 indicators or indicator of gestational diabetes”).
groups. Following this, data sources were identi- ▶▶ Between 1998 and 2010, RKI surveys show that
fied for these indicators and initial reporting for- the prevalence of overweight (including obesity),
mats were developed. The current report presents an important risk factor in the development of
the first results from the Diabetes Surveillance and type 2 diabetes, remained constant at 60 % for
is complemented by a website (http://diabsurv.rki. the 18 - to 79 -year-old population. However, the
de). Further expansion of the data basis and further proportion of obesity increased for men (fact
development of analyses and reporting formats are sheet “Overweight and obesity”).
planned for the second phase of the project until ▶▶ Physical inactivity and smoking are further
the end of 2021. Within the four fields of action, behavioural risk factors linked to the develop-
initial findings on diabetes in Germany can be ment of type 2 diabetes. An RKI survey from
summarised as follows: 2014 indicates that just over half of all adults in
Germany do not meet World Health Organiza-
tion recommendations for weekly endurance
exercise, while nearly one-quarter of adults say
they smoke occasionally or daily (fact sheet
“Physical inactivity” and fact sheet “Smoking”).
Nevertheless, RKI surveys show a reduction in
smoking between 2003 and 2014.
▶▶ There are significant social differences regarding
the risk factors considered. The prevalence of
risk factors for people in the low-education group
is considerably higher (http://diabsurv.rki.de).National Diabetes Surveillance Robert Koch Institute 11
Field of action 2 Field of action 3
“Improving the early detection and treatment “Reducing the complications of diabetes”
of diabetes”
Not only diabetes itself, but also co-morbidities
There is an increasing number of people being and secondary diseases signify an increased
diagnosed with diabetes and receiving treat- burden on the individual.
ment within the health care system.
▶▶ According to an RKI survey, around 15% of peo-
▶▶ According to an RKI survey, 7.2 % of the 18 - to ple with diabetes in 2014 presented with depres-
79 -year-old population in 2010 had known diabe- sive symptoms, approximately twice that of peo-
tes, and a further 2.0 % had previously unknown ple without diabetes (fact sheet “Depressive
diabetes. While the prevalence of known diabe- symptoms”).
tes had increased since 1998 across all education ▶▶ Cardiovascular co-morbidities are far more fre-
groups, there was a similar-sized decrease in the quent among 45 - to 79 -year-olds with type 2 dia-
prevalence of unknown diabetes during the betes than among people who do not have this
same period (fact sheet “Prevalence of known condition. According to RKI surveys, between
and unknown diabetes”). 1998 and 2010 the prevalence of cardiovascular
▶▶ Claims data for all people covered by statutory co-morbidities decreased particularly among
health insurance shows significant regional differ- women with type 2 diabetes (fact sheet “Cardio-
ences in the prevalence of documented diabetes vascular diseases”).
(fact sheet “Prevalence of documented diabetes”). ▶▶ Over time, diabetes can damage small blood ves-
▶▶ RKI surveys show that in 2010, around 80 % of 45 - sels and nerves, leading to secondary diseases
to 79 -year-olds with known type 2 diabetes specific to diabetes. Analyses of statutory health
achieved the recommended HbA1c target, which insurance data show that in 2013, over 15% of all
takes factors such as age and diabetes-related insured persons with diabetes had documented
co-morbidities into account. This is a marked chronic kidney disease, and over 13% had docu-
increase in comparison with 1998 (fact sheet mented polyneuropathy (fact sheet “Diabetic
“Graded HbA1c target”). kidney disease” and fact sheet “„Diabetic poly-
▶▶ Around 70 % of 45 - to 79 -year-olds with known neuropathy“”).
type 2 diabetes are on antidiabetic medication, a ▶▶ Polyneuropathy increases the risk of developing
figure which remained almost constant between diabetic foot syndrome, which can lead to ampu-
1998 and 2010. Findings of RKI surveys indicate tation if an infection becomes uncontrollable.
that the proportion of those receiving metformin Around 6% of persons with diabetes insured by
monotherapy or a combined therapy of insulin statutory health insurance in 2013 had docu-
and oral antidiabetic agents increased (fact sheet mented diabetic foot syndrome. In 2017, there
“Treatment profiles”). were approximately 11 amputations of the lower
▶▶ Health-related quality of life is lower for people limb above the ankle among persons with diabe-
with diabetes than for those without. RKI sur- tes per 100,000 residents, according to Diagno-
veys indicate that there were no changes in this sis-Related Groups (DRG) statistics (fact sheet
relation between 1998 and 2010 (fact sheet “Diabetic foot syndrome” and fact sheet “Diabe-
“Health-related quality of life”). tes-related amputations”).12 Robert Koch Institute National Diabetes Surveillance
Conclusion and outlook
In view of the predicted rise in the prevalence
Field of action 4 of known diabetes1, prevention and care of dia-
“Reducing the burden and costs of disease” betes remains a challenge for public health.
For this reason, it is important to continue
Diabetes markedly reduces the number of reducing the diabetes risk of the population
healthy life years and is associated with high through behavioural and settings-based mea
costs to the health care system. sures. Persons with diabetes face increased
rates of mortality, more frequent co-morbidi-
ties and a lower quality of life than those with-
▶▶ According to disease-related cost calculations by out diabetes, all of which indicates a need to
the Federal Statistical Office, diabetes care costs further improve quality of diabetes care. The
EUR 7.4 billion in 2015. Estimates from 2009 tak- next project phase of the Diabetes Surveillance
ing co-morbidities and secondary diseases into will look to strengthen the data basis for the
account calculated the cost of diabetes at approx- future surveillance of non-communicable dis-
imately EUR 21 billion for that year (fact sheet eases. In addition, specific target groups and
“Direct costs”). all life phases will be considered with the aim
▶▶ Diagnosis-Related Groups (DRG) statistics indi- of developing targeted public health measures.
cate that the number of inpatients with diabetes
as their documented main diagnosis decreased
for both sexes between 2015 and 2017, with rates
for women lower than for men. The regional dis-
tribution of these so-called ambulatory care-sen-
sitive hospitalisations is related to the regional
distribution of diabetes prevalence (fact sheet
“Ambulatory care-sensitive hospitalisations”).
▶▶ The number of pension applications to the Ger-
man Pension Insurance Scheme on the grounds
of diabetes-related reduced earning capacity
decreased between 2013 and 2016. These rates
show clear regional differences that relate to the
prevalence of diabetes in the federal states (fact
sheet “Reduced earning capacity pension”).
▶▶ The mortality rate for people with documented
diabetes aged 30 and over is around 50 % higher
than for people of the same age who do not have
diabetes (fact sheet “Mortality”).
▶▶ The expected number of healthy life years is
lower for people who have diabetes than for
those who do not. Depending on age, as many as
12 remaining healthy life years may be lost (fact
sheet “Healthy life years”).National Diabetes Surveillance Robert Koch Institute 13
Introduction and background
What is diabetes mellitus? Table 1. The most frequent types of diabetes.4, 12
Type 1 diabetes
Diabetes mellitus is a non-communicable disease ▶▶ Pathogenesis
characterised by chronically elevated blood glucose Absolute lack of insulin due to the destruction of
insulin-producing ß cells in the pancreas
levels. Secondary diseases include serious and ▶▶ Cause
multiple organ complications stemming from Usually immune-mediated
damage to small blood vessels and nerves. These ▶▶ Treatment
reduce not only the life expectancy but also the Always with insulin
remaining healthy life years for people with diabe-
tes in comparison to those of the same age without Type 2 diabetes
diabetes.2, 3 ▶▶ Pathogenesis
There are different types of diabetes (Table 1),4 Relative lack of insulin due to insulin resistance and
with type 2 diabetes being the most frequent form partially diminished insulin production
in adults.5 While factors such as more advanced ▶▶ Cause
age and genetic disposition are unmodifiable, Interaction of several risk factors such as age, genetics,
obesity and lack of physical activity
many type 2 diabetes risk factors are, in principle, ▶▶ Treatment
modifiable. This provides opportunities for behav- Lifestyle changes, oral antidiabetic agents, GLP-1 ana-
ioural and settings-based prevention measures. logues or insulin (depending on state of disease)
Such prevention measures should either be evi-
dence-based or accompanied by scientific evalua- Gestational diabetes
tion if their effectiveness has not yet been shown. ▶▶ Pathogenesis
Looking beyond type 2 diabetes, the risk factors Develops during pregnancy due to greater insulin
also contribute to the development of other com- resistance in the second half of the pregnancy
▶▶ Cause
mon, non-communicable diseases, many of which
Similar to type 2 diabetes, an interaction of genetic
frequently appear as co-morbidities of diabetes. factors and health-related lifestyle
Demographic and social changes since the mid- ▶▶ Treatment
1960s have led to a profound shift in the spectrum Primarily lifestyle changes; should these prove ineffective
of diseases observed in the population, with an then insulin therapy is recommended
increased prevalence of non-communicable dis-
eases. During this period, the prevalence (fre-
quency of cases in the population over a defined There are also other comparatively rare forms of
period of time) and incidence (frequency of new diabetes with entirely different causes. The second
cases relative to the population over a defined main form of diabetes, type 1 diabetes usually
period of time with no previous history of diabetes) develops in children and adolescents and requires
of type 2 diabetes increased in Germany and lifelong insulin therapy. It represents a great bur-
around the world.6, 7 Frequency, sequelae, potential den on the individual and places heavy demands
to prevent individual and environmental risk fac- on the quality of medical care. There are other rare
tors as well as the strong link to other non-commu- forms of diabetes related to congenital or acquired
nicable diseases are the reasons why type 2 diabe- underlying diseases.5 Unlike in adults, type 2 dia-
tes is hugely significant for public health. 8–10 betes is rare in children and adolescents.11
One particular form of diabetes is gestational
diabetes. This is a metabolic disorder that develops
during pregnancy and which often causes preg-
nancy complications.4, 5 Gestational diabetes
increases the mother’s risk of developing type 2
diabetes at a later stage 5.14 Robert Koch Institute National Diabetes Surveillance
What are the aims of the Diabetes in Germany with and without diabetes.18 The long-
Surveillance in Germany? term experience of the federal states with health
reporting can also be utilised. In future, results of
the Diabetes Surveillance should be presented with
Public health surveillance is understood to be the regionalised figures as possible, thereby support-
systematic, continuous and problem-oriented col- ing reporting at federal state level.19
lection and analysis of health data. The aim is to
provide important, up- to date, tailored informa-
tion to key players within the health care system,
thereby supporting the planning, implementation What content comprises the Diabetes
and evaluation of public health measures.13, 14 Orig- Surveillance?
inally used in the field of infectious diseases and
infection protection, surveillance is now becoming
more important in the prevention and control of The first phase (2015 – 2019) of the Diabetes Sur-
non-communicable diseases.13 This can also be veillance project has focused on developing a sci-
seen in the international action plans of the World entific framework. In a multi-step, consensus-find-
Health Organization (WHO).15 ing process,40 indicators or indicator groups
Due to the high relevance of diabetes for pub- relevant to health policy were selected and assigned
lic health, the Robert Koch Institute (RKI) began to four fields of action to illustrate the disease and
establishing a diabetes surveillance system in Ger- care situation (Figure 1).20 While the first field of
many in 2015, as part of a Federal Ministry of action Reducing the risk of diabetes addresses the
Health (BGM) project. The project is overseen by prevalence of type 2 diabetes risk factors and the
an interdisciplinary scientific advisory board (see incidence of diabetes, the second field of action
http://diabsurv.rki.de). The goal of the Diabetes Improving the early detection and treatment of dia-
Surveillance is to establish a transparent, consist- betes focuses on the prevalence of diagnosed and
ent and comprehensive data and information basis unknown diabetes, as well as on various aspects of
on disease and health care specifically in regard to process and outcome quality in the early detection
diabetes in Germany. This data and information and treatment of diabetes. The third field of action
basis is aimed at players within health policy, Reducing the complications of diabetes is con-
research and health practice. As a consequence, cerned with the frequency of secondary diseases
there was close co-operation with the department and co-morbidities. The fourth field of action,
for “Prevention of Diabetes Mellitus, Associated Reducing the burden and costs of disease outlines
Risk Factors and Secondary Diseases” at the Fed- aspects of the diabetes disease burden for individ-
eral Centre for Health Education (BZgA), the for- uals and for society as a whole.
mer “National Education and Communication
Strategy on Diabetes Mellitus in Germany”. The
BZgA strategy aims to provide a range of educa-
tional and informative materials on all stages of the
disease that are target-group oriented, comprehen-
sive, quality-assured and evidence-based. The
BZgA’s diabetes network compiles and organises
existing education, information and communica-
tion measures on diabetes prevention and treat-
ment, as well as developing and promoting new
material.16 Among these is the diabetes informa-
tion portal developed by the German Diabetes Cen-
tre (DDZ), the German Centre for Diabetes
Research (DZD) and Helmholtz Zentrum
München.17 In 2017, the RKI and the BZgA collab-
orated on a nationwide telephone interview survey
to assess what information was needed by adultsNational Diabetes Surveillance Robert Koch Institute 15
Figure 1. Consensus-based indicator set for the Diabetes Surveillance 21
Field of action 1 Field of action 3
Reducing the risk of diabetes Reducing the complications of diabetes
Core indicators Core indicators
▶▶ Incidence of documented diabetes ▶▶ Depressive symptoms
▶▶ Prevalence of gestational diabetes ▶▶ Cardiovascular diseases
▶▶ Overweight and obesity ▶▶ Diabetic retinopathy
▶▶ Physical inactivity ▶▶ Diabetic kidney disease
▶▶ Smoking ▶▶ Renal replacement therapy
▶▶ Social deprivation ▶▶ Diabetic polyneuropathy
▶▶ Diabetic foot syndrome
Supplementary indicators
▶▶ Diabetes-related amputations
▶▶ Prediabetes
▶▶ Frequency of severe hypoglycaemia
▶▶ Sugar-sweetened beverages
▶▶ Absolute diabetes risk Supplementary indicators
▶▶ Contextual factors ▶▶ Risk of a cardiovascular events
▶▶ Pregnancy complications
Field of action 2 Field of action 4
Improving the early detection and Reducing the burden and
treatment of diabetes costs of disease
Core indicators Core indicators
▶▶ Prevalence of known/documented diabetes ▶▶ Direct costs
▶▶ Prevalence of unknown diabetes ▶▶ Ambulatory care-sensitive hospitalisations
▶▶ DMP participation rate ▶▶ Reduced earning capacity pension
▶▶ Achievement of DMP quality objective ▶▶ Mortality
▶▶ Quality of type 2 diabetes care ▶▶ Years of life lost (YLL)
▶▶ Treatment profiles ▶▶ Healthy life years (HLY)
▶▶ Health-related quality of life
Supplementary indicators
▶▶ Screening for gestational diabetes
▶▶Years lived with disability (YLD)
▶▶ Age at diagnosis
▶▶ Disability-adjusted life years (DALYs)
Supplementary indicators
▶▶ Health check-up
▶▶ Patient satisfaction16 Robert Koch Institute National Diabetes Surveillance
Which data sources are used by Figure 2. Current data sources for the National Diabetes
Surveillance22
the Diabetes Surveillance?
RKI health surveys Disease registries
The Diabetes Surveillance uses multiple data
sources for their indicators (Figure 2). These can be
divided into primary and secondary data sources.
Primary data are systematically captured via prede-
fined questions. Secondary data are originally col-
lected or documented for another purpose or in
answer to other questions.
Primary data used in the Diabetes Surveil-
lance notably comprises data from RKI interview
and examination surveys which are representative Claims and Official
of the German population (German National documentation data statistics
Health Interview and Examination Survey 1998
(GNHIES98); German Health Interview and Exam-
ination Survey for Adults (DEGS); German Health Advantages of claims and documentation data
Update (GEDA)). ▶▶ Usually include a large number of cases that
allow for example differentiated analyses by
Advantages of RKI health surveys region as well as detailed evaluations for the
▶▶ Contain measurement and laboratory data assessment of secondary diseases and
and therefore allow for example detection of co-morbidities
hitherto unknown diabetes ▶▶ Periodic analysis without large time lag are
▶▶ Contain subjective aspects of health as well possible
as behavioural and social risk factors,
thereby for example allowing the population Limitations of claims and documentation data
groups most affected to be identified accord- ▶▶ Data are documented for treatment and bill-
ing to social status ing purposes, data quality depends on cod-
ing which in turn affects the completeness
Limitations of RKI health surveys and validity of data
▶▶ Relatively long intervals between data collec- ▶▶ Data from individual SHI are not representa-
tion waves, in particular for surveys including tive of all people covered by SHI and do not
examinations provide information on privately insured per-
▶▶ Results have limited representativity for cer- sons
tain population groups such as the seriously
ill, the very old, people living in care homes, In addition, the Diabetes Surveillance uses data
and people with insufficient German lan- from national diabetes patient documentation his-
guage skills tory (DPV) and from regional epidemiologic diabe-
tes registries. These registry data play an important
The secondary data used notably includes claims role, in particular for the less frequent type 1 dia-
data routinely documented by statutory health betes and the equally rare type 2 diabetes in chil-
insurance (SHI), the so-called DaTraV data, Diag- dren and adolescents. Calculation of individual
nosis-Related Groups (DRG) statistics provided by indicators also requires data from official statistics
the Federal Statistical Office, pension entitlement such as cause of death statistics from the Federal
diagnoses for people with a reduced capacity to Statistical Office.
work from the German Pension Insurance, data
from obstetrics quality assurance based on federal
perinatal statistics, and documentation data from
the Disease Management Programmes (DMP).National Diabetes Surveillance Robert Koch Institute 17
What does this report contain?
This first report of the Diabetes Surveillance
in Germany summarises the key results from
the initial project phase. The report is divided
into four chapters, one for each field of action.
Each chapter begins with a summary of results
for that field of action, followed by a short,
two-page fact sheet describing the core indica-
tors (approximately five) for each field of
action. These core indicators were selected in
discussions with the scientific advisory board
and with data availability in mind. Depending
on data availability, indicators are described as
they develop over time, and are stratified by
sex, age, education and region.
These initial results of the Diabetes Sur-
veillance are presented here in the form of a
report, supplemented by a website (http://
diabsurv.rki.de). The website describes the
methodology in detail, as well as the results for
those indicators not included as fact sheets in
this report. Periodic reports in a printed for-
mat are also planned. Reporting formats will
be differentiated and developed appropriately
in close consultation with specific target
groups.18 Robert Koch Institute National Diabetes Surveillance
Field of action 1
Reducing the risk of diabetesReducing the risk of diabetes Field of action 1 19
Background mind, two key issues were selected for the field of
action 1 Reducing the risk of diabetes and described
with indicators. These are the incidence of diabe-
Different predictive scenarios related to type 2 dia- tes and the prevalence of key influencing factors
betes consistently indicate an increase in the num- related to behaviour or settings which can be influ-
ber of diabetes patients in the future. The speed of enced by health policy. In a structured, consen-
this predicted increase will depend in particular on sus-finding process, six of the ten indicators
how many new cases develop and thus on tempo- selected for this field of action were classified as
ral development in key type 2 diabetes risk factors.1 core indicators, while four were classified as sup-
As is the case with other non-communicable dis- plementary indicators (Figure 3). The following fact
eases that are highly relevant to public health, sheets in this chapter present the current data sit-
these include factors that are potentially modifia- uation and – where possible – the temporal devel-
ble such as health-related behaviour, living condi- opments for five core indicators.
tions and environmental conditions.23 With this in
Figure 3. Indicators field of action 1
Core indicators Supplementary indicators
▶▶ Incidence of documented diabetes Prediabetes
▶▶ Prevalence of gestational diabetes Sugar-sweetened beverages
▶▶ Overweight and obesity Absolute diabetes risk
▶▶ Physical inactivity Contextual factors
▶▶ Smoking
Social deprivation
The indicators presented in fact sheets in this issue are marked in colour.
Please note: Results for the other field of action 1 indicators as well as information on methodology and data sources are
available on the Diabetes Surveillance website http://diabsurv.rki.de.
Results at a glance intervals. According to an initial analysis for the
year 2012, about 500,000 people, or 1.2 % of the
adult population, develop diabetes every year (fact
Seen as a whole, the few studies on the incidence sheet “Incidence of documented diabetes”).25
of diabetes in Germany indicate a significant Gestational diabetes is a particular form of dia-
increase in incidence rates over the past decades.6 betes that can develop temporarily during preg-
Unhealthy lifestyle and behaviour have contributed nancy. This form of diabetes is a risk factor for
to this development, as have changes to diagnostic both pregnancy complications and the develop-
criteria and improved clinical diagnostics. Having ment of type 2 diabetes at a later stage.26 Using per-
said this, a recent analysis of claims data from stat- inatal statistics, the quality assurance in obstetrics
utory health insurance physicians by the Central collects data on the number of hospital births
Research Institute of Ambulatory Health Care in where the mother has gestational diabetes docu-
Germany (Zi, Zentralinstitut für die kassenärztli- mented in her maternity log relative to the total
che Versorgung in Deutschland) indicates that number of hospital births in a given year.27, 28
between 2012 and 2014, there was a slight decline According to this, gestational diabetes prevalence
in the incidence of type 2 diabetes among adults increased from less than 2 % in 2002 to over 4 % in
aged 40 and over.24 The Diabetes Surveillance indi- 2011, and – after universal screening for gestational
cator on the incidence of documented diabetes, diabetes was introduced in 2012 – reached 5.9 % in
which was based on DaTraV data, provides a basis 2017 (fact sheet “Prevalence of gestational diabe-
for the future monitoring of incidence over shorter tes”). It should be noted that these prevalence esti-20 Robert Koch Institute National Diabetes Surveillance
mates rely on the documentation of gestational dia- Within the health policy context
betes in maternity logs. Analyses of other data
sources indicate it is likely that the prevalence of
gestational diabetes based on perinatal statistics is Since many of the risk factors for the predominant
being underestimated.29, 30 Missing information in type 2 diabetes and for gestational diabetes are
maternity logs can result in inaccurately low modifiable, there is potential for primary preven-
reported figures.31 tion. Preventable risk factors for type 2 diabetes
Nationwide RKI health surveys provide the such as physical inactivity, smoking and obesity are
data basis for assessing the prevalence of key shared by other relevant non-communicable dis-
behavioural type 2 diabetes risk factors over time. eases (cardiovascular diseases, cancer, chronic
Between 1998 and 2010, the prevalence of over- lung diseases). As a result, there is a social respon-
weight (including obesity) among 18 - to 79 -year- sibility to implement settings-based prevention
olds remained constant at 60.0 % (fact sheet “Over- measures so that all social groups can be reached.
weight and obesity”). Overall, the prevalence of These prevention measures should be both sensi-
physical inactivity32, 33 and of smoking34, 35 has tive to the effects of stigmatisation and evi-
decreased in the past few years. Nevertheless, more dence-based. In addition, they should be accompa-
than half of all adults do not meet the WHO mini- nied by scientific evaluation if their effectiveness
mum recommendation of 2 .5 hours of aerobic has not yet been shown. Major primary prevention
physical activity per week (fact sheet “Physical inac- objectives and measures are embedded in the
tivity”), and nearly one-quarter of adults smoke WHO’s Global Action Plan for the Prevention and
occasionally if not daily (fact sheet “Smoking”). Control of Non-communciable Diseases 2013 -
With significantly higher prevalences recorded for 2020,15 in the national health targets for Type 2 dia-
socially deprived groups, pronounced differences betes mellitus (Diabetes mellitus Typ-2), Health
in the distribution of behavioural risk factors and motherhood (Gesundheit rund um die Geburt),
remain. Regional differences for indicators can Growing up healthy (Gesund aufwachsen) and
also be observed (see http://diabsurv.rki.de). Healthy ageing (Gesund älter werden),38 in Germa-
Information on a further three of the ten indi- ny’s National Sustainable Development Strategy39
cators (Prediabetes, Sugar-sweetened beverages and in the National Action Plan IN FORM.40 As
and Absolute diabetes risk) are available on the declining smoking rates show, measures that apply
Diabetes Surveillance website (http://diabsurv.rki. to the entire population such as increasing the tax
de). These indicate that in recent decades, there on tobacco and legally regulating the protection of
has been an increase in the frequent consumption non-smokers41 have already had a positive effect.
of sugar-sweetened beverages. Currently, around However, social disparities in the prevalence of
one in six 18 - to 79 -year-olds consume at least one behavioural and settings-related risk factors persist.
sugar-sweetened beverage per day. A comprehen- Establishing the Health in all Policies approach
sive evaluation of the risk situation could be sup- and implementing public health measures within
ported by a summary measure of known diabetes high-risk population groups – at the municipal or
risk factors such as risk scores for the development regional level and in particular settings (such as in
of type 2 diabetes, as well as by data on prediabetes childcare facilities, schools, or work environments)
from lab measurements of sugar metabolism. – thus remains a challenge for the future. Contact
Analyses of the indicators Absolute diabetes risk36 with players within the health care system will like-
and Prediabetes37 indicate a slight improvement in wise provide important opportunities for targeted
overall diabetes risk between 1998 and 2010. The advice and support on how to promote health (for
selection and operationalisation of settings-based example during pregnancy and birth) that could be
risk factors relevant to health policy (indicator used in scientifically monitored advisory pro-
groups Social deprivation and Contextual factors) grammes.
have not yet been completed for this initial report.
The scientific evidence must first be assessed. The
results for the settings-based risk factors will be a
key issue to the further development and comple-
tion of the Diabetes Surveillance indicators.Reducing the risk of diabetes Field of action 1 21 Next steps for the Diabetes Surveillance at the Robert Koch Institute 1. Further development of stratified analyses for all age groups (including children, ado- lescents and the very old), and to identify differences in the distribution of risk factors dependent on region, social status and migrant background. 2. Operationalisation of settings-based risk factors and measures relevant to health pol- icy (indicator groups Social deprivation und Contextual factors). 3. Differentiation of diabetes types in terms of diabetes incidence. This builds on previous analyses from co-operation projects between the Diabetes Surveillance and regional dia- betes registries, as well as documentation on diabetes patients (DPV) in Germany.42
22 Fact Sheet Field of action 1 ”Reducing the risk of diabetes”
Fact Sheets
Incidence of documented diabetes
Definition The rate of new cases (incidence) and the corresponding abso-
The indicator Incidence of document- lute number of new cases are critical for assessing disease
ed diabetes is defined as the propor-
tion of newly documented diabetes
dynamics. Incidence influences the future development of preva-
cases among all adults covered by SHI lence and the expected number of patients.1 Incidence itself is
in a given year who have not been di- dependent on the development of major diabetes risk factors.43
agnosed with diabetes in the previous
year. A new case is defined as at least
one documented hospital diagnosis of
In 2012, the incidence of documented diabetes in Germany was
diabetes or at least two verified outpa- 1.2 % of all people covered by SHI (women 1.1%; men 1.3%).
tient diagnoses (E10-E14) in the space This is equivalent to 560,762 adults. An analysis by age groups shows
of four calendar quarters. that for both men and women, incidence increased with age and
peaked in the 80 -plus age group (Figure 4).
Data source
Claims data from the approximately
70 million people covered by SHI Overall, the number of documented new cases increases sig-
(DaTraV data). nificantly with age. Generally, the assessment of incidence
within the Diabetes Surveillance will help predict changes to the risk
Data quality of developing the disease. Current results indicate a decrease in the
The quality of claims data from SHI de-
pends on conduct of documentation.
incidence of documented type 2 diabetes.24
• In 2012, around 560,000
people covered by SHI
developed diabetes for
the first time.
• Incidence increases with age
and peaks in the 80 -plus age
group.Incidence of documented diabetes Fact Sheet 23
Figure 4. Incidence of documented diabetes (in %) among adults covered by SHI in 2012 by age and sex. Source:
DaTraV data; by Schmidt et al.25
0.13 Total
Women
18–34 Years 0.16
Men
0.10
0.56
35–49 Years 0.46
0.68
1.6
50–64 Years 1.3
1.9
2.7
65–79 Years 2.5
3.0
3.0
≥80 Years 2.9
3.2
1.2
All age groups 1.1
1.3
Background Results Conclusion24 Fact Sheet Field of action 1 ”Reducing the risk of diabetes”
Prevalence of gestational diabetes
Definition Gestational diabetes is a blood glucose disorder first diagnosed
The indicator Prevalence of gestational
diabetes is defined as the proportion during pregnancy. In most women, this form of diabetes dis-
of women giving birth in hospital (in- appears postpartum, although it increases the risk of pregnancy com-
cluding stillbirths) in a given year with plications for both mother and child as well as the risk of the mother
a diagnosis of gestational diabetes
documented in their maternity log.
developing type 2 diabetes at a later stage.
Data source In 2017, 44,907 out of 761,176 women giving birth in hospital in
Obstetrics quality assurance based on Germany had documented gestational diabetes (5.9 %). Since
federal-state perinatal statistics.27, 28 2002, this number steadily increased (Figure 5). The prevalence of doc-
umented gestational diabetes varies from region to region (Figure 6).
Data quality
Incomplete documentation of gesta-
tional diabetes in maternity logs The prevalence of gestational diabetes is potentially increasing
means it is likely that prevalence is due to several factors. On the one hand, the average age of
being underestimated. mothers giving birth and the rate of obesity have increased, both of
which are risk factors for gestational diabetes.28, 44 On the other hand,
gestational diabetes guidelines were changed in 2012, and SHI began
to cover screening examinations, which may have led to an increase
in diagnoses and documentation. Studies based on other data sources
• In 2017, around 45,000 preg- show higher estimates of gestational diabetes.29, 30 This underscores
nant women had gestational the need for studies to improve data quality, for example by review-
diabetes. ing possible gaps in documentation.
• Based on perinatal statistics
data, hospital obstetrics qual-
ity assurance shows a contin-
uous increase in deliveries
with gestational diabetes
since 2002.
• Highly disparate estimates
and clear regional differ-
ences call for a review of data
quality.Prevalence of gestational diabetes Fact Sheet 25
Figure 5. Temporal development of the proportion of women giving birth in hospital (in %) who have documented
gestational diabetes. Source: aQua-Institute, IQTIG Geburtshilfe27, 28
New guideline for 5.9
gestational diabetes 5.4
5.0
4.4 4.3 4.4 4.5
3.7
3.4 3.4
2.7
2.2 2.3 2.4
1.8
1.5
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Figure 6. Proportion of women giving birth in hospital in 2017 (in %) who have documented gestational diabetes by
region. Source: Federal quality assurance; own calculation
Mecklen-
burg-Western
Pomerania
5.2
North West
5.5 Berlin and
Saxony- Brandenburg
Anhalt 6.1
North Rhine- 7.3
Westphalia
7.4
Thuringia Saxony
Hesse
5.4 5.3
Rhineland- 5.4
North West includes:
Palatinate
• Lower Saxony
6.8 • Schleswig-Holstein
Saarland Bavaria • Bremen
• Hamburg
6.5 5.0
Baden-
Wuerttemberg ≤ 5.4 %
4.9 5.4 – 5.9 %
5.9 – 6.4 %
6.4 – 6.9 %
≥ 6.9 %
Background Results Conclusion26 Fact Sheet Field of action 1 ”Reducing the risk of diabetes”
Overweight and obesity
Definition Overweight describes a condition in which the weight of a
The WHO45 classification scheme de- given body is higher than normal relative to its height. Severe
fines the indicator Overweight as the
proportion of the population with a
overweight is termed obesity. Overweight and obesity are major risk
Body Mass Index (BMI) of ≥ 25.0 kg/ factors for the development of non-communicable diseases such as
m² and the indicator Obesity as the type 2 diabetes.45
proportion of the population with a
BMI of ≥ 30.0 kg/m². BMI is calculated
using measurement data on body
In 2010, the prevalence of overweight (including obesity) for
weight and height. the 18 - to 79 -year-old population was 60.0 % (women 53.0 %;
men 67.1%), while 23.6% of adults (women 23.9 %; men 23.3%) were
Data source obese (Figure 7). There are twice as many obese people in the low-ed-
National RKI interview and examina- ucation group as in the high-education group (Figure 8). When com-
tion surveys (GNHIES98, DEGS1).
pared with 1998, the prevalence of overweight (including obesity)
Data quality remained stable for both sexes (Figure 7), while the prevalence of obe-
RKI interview and examination surveys sity among men increased.
are based on measurement data and
provide representative results for the Nearly one-quarter of 18 - to 79 -year-olds living in Germany is
18- to 79-year-old resident population
of Germany.
obese. It is vital to prevent any increase in the prevalence of
obesity by expanding appropriate measures as per the WHO’s Global
Action Plan objectives15 and the German government’s 2016 sustain-
able development strategy.
• Nearly one-quarter of all
18 - to 79 -year-olds is obese.
• Men and women in the
low-education group are
twice as likely to be obese as
those in the high-education
group.Overweight and obesity Fact Sheet 27
Figure 7. Temporal development of the prevalence of overweight (including obesity) and obesity (in %) in the 18- to
79-year-old population by sex. Source: GNHIES98, DEGS1; by Mensink et al.46
67.1 67.1
60.0 60.0
53.0 53.0
Overweight
23.6 22.5 23.9 23.3
20.7 18.9 (including obesity)
Obesity
1998 2010 1998 2010 1998 2010
Total Women Men
Figure 8. Prevalence of overweight (including obesity) and obesity (in %) in the 18- to 79-year-old population in 2010 by
education group and sex. Source: DEGS1; own calculations
75.7
Overweight (including obesity)
72.0 Obesity
68.6
64.2
61.8
53.3 51.9
45.4
35.1
32.8 34.9 30.5
19.9 20.6
19.2 14.7
12.1
8.5
Total Women Men Total Women Men Total Women Men
Low-education group Medium-education group High-education group
Background Results Conclusion28 Fact Sheet Field of action 1 ”Reducing the risk of diabetes”
Physical inactivity
Definition Physical activity describes any form of movement that increases
The indicator Physical inactivity is energy metabolism. This can take place in different areas: as
defined as the proportion of the popu-
lation who do not meet WHO47 recom-
recreation, in the work environment, at home or as movement from
mendations on moderate-intensity aer- one place to another. The indicator used here focusses exclusively on
obic physical activity (≥ 2.5 hours per physical activities during leisure time.48 Work-related physical activ-
week) during leisure time. ity is not included. Physical inactivity (i.e. failure to meet the recom-
mendations mentioned above) is a major risk factor for the develop-
Data source ment of non-communicable diseases such as type 2 diabetes.
National RKI interview survey
(GEDA 2014/2015-EHIS).
In 2014, the prevalence of physical inactivity in the adult popu-
Data quality lation was 54.7 % (women: 57.4 %; men: 52.0 %) (Figure 9), with
RKI interview surveys provide repre- only minor differences between age groups. At an advanced age,
sentative results for the resident popu-
lation of Germany aged 18-plus.
physical limitations lead to an increase in inactivity. There are slight
differences between federal states: whereas over 60 % of the popula-
tion in Saxony (women: 65.5%; men: 60.2 %) and Mecklenburg-West-
ern Pomerania (women: 60.8 %; men: 60.6%) were physically inactive,
less than 50 % were in Bremen (women: 52.4 %; men: 42.1%) and
Schleswig Holstein (women: 53.7 %; men: 45,2 %) (Figure 10). In addi-
tion, fewer people in the high-education group (44.3%) were physi-
cally inactive in their leisure time than those in the low-education
group (62.3%) (http://diabsurv.rki.de).
Across all age groups, more than half of all adults in Germany
do not meet the WHO recommendation of at least 2.5 hours of
aerobic physical activity per week. As a result, it is vital that public
health measures promoting physical activity, such as those included
in the National Recommendations for Physical Activity and Physical
• Over half of all adults do not Activity Promotion, be further expanded.49
meet the WHO recommen-
dations of 2.5 hours of mod-
erate-intensity aerobic physi-
cal activity per week.
• The prevalence of physical
inactivity varies according to
education level and federal
state.Physical inactivity Fact Sheet 29
Figure 9. Prevalence of physical inactivity in the adult population (in %) in 2014 by age and sex.
Source: GEDA 2014/2015-EHIS; by Finger et al.50
51.2 Total
Women
18–34 Years 56.9
Men
45.9
56.9
35–49 Years 58.3
55.6
53.1
50–64 Years 51.5
54.8
53.4
65–79 Years 57.5
48.6
77.7
≥80 Years 85.0
66.6
54.7
All age groups 57.4
52.0
Figure 10. Prevalence of physical inactivity in the adult population (in %) in 2014 by sex and federal state.
Source: GEDA 2014/2015-EHIS; by Finger et al.50
53.7 45.2
60.8 60.6
51.8 51.3
52.4 57.9 42.1 50.8
52.8 52.4
63.6 60.3 53.9 54.8
58.8 52.0
65.5 60.2
55.9 67.2 51.0 54.0
58.9 52.7
64.1 52.0
55.6 49.6
≤ 54.9 ≤ 45.8
55.0 51.9
54.9 – 58.0 45.8 – 49.5
58.0 – 61.1 49.5 – 53.2
61.1 – 64.1 53.2 – 56.9
Women ≥ 64.1 ≥ 56.9 Men
Background Results Conclusion30 Fact Sheet Field of action 1 ”Reducing the risk of diabetes”
Smoking
Definition Smoking cigarettes and other tobacco products is one of the
The indicator Smoking is defined as most significant risk factors for non-communicable diseases,
the proportion of people who smoke
occasionally or daily.51
in particular for lung and cardiovascular diseases.51
Data source In 2014, the prevalence of smoking in the adult population was
National RKI interview surveys 23.8 % (women: 20.8 %; men: 27.0 %). The prevalence of smok-
(GESTel03, GEDA 2009, GEDA 2010, ing is significantly higher for younger and middle-aged people and
GEDA 2012, GEDA 2014/2015-EHIS).35
decreases with age (Figure 11). More people in the low-education
Data quality (22.9 %) and medium-education groups (26.5%) smoke than in the
RKI interview surveys provide re high-education group (16.5 %). From a regional perspective, smok-
presentative results for the resident ing prevalences in Germany are higher in the north than in the south,
German population aged 18-plus. and higher in the east than in the west. Prevalence is also higher in
the federal city-states than in the territorial federal states (http://diab-
surv.rki.de). Between 2003 and 2014, the prevalence of smoking
among adults decreased (Figure 12).
Despite a decrease in smoking prevalence in Germany in
• In 2014, nearly one-quarter recent years,34, 35 nearly one-quarter of adults still report that
of adults in Germany they smoke occasionally or daily. Further efforts to prevent smoking
reported that they smoked, are therefore vital public health measures that can reduce the risk of
women less frequently than diabetes and other non-communicable diseases. Such measures
men. should consider new forms of nicotine consumption such as e-ciga-
rettes and (e-)shishas.
• The prevalence of smoking
is significantly higher in the
low-education and medium-
education groups than in the
high-education group.
• Reducing the prevalence
of smoking remains a high
priority for public health.Smoking Fact Sheet 31
Figure 11. Prevalence of smoking in the adult population (in %) in 2014 by age and sex. Source: GEDA 2014/2015-EHIS; by
Zeiher et al.51
33.1
18–34 Years 28.7
37.3
29.5
35–49 Years 26.8
32.1
24.8
50–64 Years 22.6
27.0
9.1
65–79 Years 8.1
10.2
3.0
≥80 Years 2.0
4.3
23.8
Total
All age groups 20.8
Women
27.0 Men
Figure 12. Temporal development of the prevalence of smoking in the adult population (in %) by sex. Source: GESTel03,
GEDA 2009, GEDA 2010, GEDA 2012, GEDA 2014/2015-EHIS; by Hoebel et al,34 Lampert et al.35
38.8
Men
33.8 33.9 33.9
Total 31.4
29.9 30.0
Women 27.6 27.0
29.2
26.1 26.2 23.8
23.9
20.8
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Background Results Conclusion32 Robert Koch-Institut Nationale Diabetes-Surveillance
Field of action 2
Improving the early detection and treatment of diabetesImproving the early detection and treatment of diabetes Field of action 2 33
Background Against this backdrop, nine core indicators and
two supplementary indicators or indicator groups
were selected for the field of action 2 Improving
The latency period between the onset of diabetes the early detection and treatment of diabetes.
and its diagnosis is estimated to be several years.52 These include the prevalence of known and
Some persons with unknown diabetes are already unknown diabetes, participation rates for check-
presenting with diabetic complications or cardio- ups and various aspects of diabetes care. The fol-
vascular co-morbidities by the time they are diag- lowing fact sheets describe five core indicators
nosed with diabetes.53, 54 This highlights the impor- with available data on the current situation and
tance of early detection and improving treatment development over time (Figure 13).
for persons with diabetes.
Figure 13. Indicators for the field of action 2.
Core indicators Supplementary indicators
▶▶ Prevalence of known/documented diabetes Health check-up
▶▶ Prevalence of unknown diabetes Patient satisfaction
DMP participation rate
Achievement of DMP quality objective
▶▶ Quality of type 2 diabetes care: graded HbA1c target
▶▶ Treatment profiles
▶▶ Health-related quality of life
Screening for gestational diabetes
Age at diagnosis
The indicators presented in fact sheets in this issue are marked in colour.
Please note: Results for the indicators of the field of action 2 not included here as well as information on methodology and
data sources are available on the Diabetes Surveillance website http://diabsurv.rki.de.
tes”). Prevalence estimations of documented dia-
Results at a glance betes across all age groups and at a regional level
have been enabled by claims data of people covered
by SHI (DaTraV data) (fact sheet “Prevalence of
Different data sources consistently show that there documented diabetes”). There are considerable dif-
has been a significant increase in the prevalence of ferences in prevalence between federal states, dif-
known diabetes in Germany since the 1960s.6 The ferences which reflect the regional patterns
interpretation of overall diabetes development observed in previous epidemiologic analyses.55, 56
requires the parallel collection of data on cases of Here, it should be noted that prevalence estimates
known and unknown diabetes. Data collected in for documented diabetes based on DaTraV data are
RKI interview and examination surveys show an generally around 2 percentage points higher than
increase in the prevalence of known diabetes to prevalence estimates for known diabetes in epide-
7.2% in the 18 - to 79 -year-old population between miological studies.6
1998 and 2010. This increase was proportional to a Up until 2018, people aged 35 and over who
decrease in the prevalence of unknown diabetes to were covered by SHI were offered a preventive
2.0% in the same age group, which means that the medical examination (Check-up 35) for diabetes
total prevalence of diabetes remained fairly stable and other chronic diseases once every two years. Zi
during this period. Inequalities in health across data show a 48.0% participation rate for the years
education groups also remained unchanged (fact 2016/2017 (http://diabsurv.rki.de). Since April 2019,
sheet “Prevalence of known and unknown diabe- people aged 35 and over have been offered a healthYou can also read
